Chest
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Survivors of acute lung injury (ALI) and other critical illnesses often experience substantial posttraumatic stress disorder (PTSD) symptoms. However, most questionnaires have not been validated against a PTSD diagnostic reference standard in this patient population. Hence, in the current study of survivors of ALI, we evaluated the Impact of Events Scale-Revised (IES-R), a questionnaire measure of PTSD symptoms, against the Clinician-Administered PTSD Scale (CAPS), the current state-of-the-art PTSD diagnostic reference standard, which also provides a quantitative assessment of PTSD symptoms. ⋯ The IES-R appears to be an excellent brief PTSD symptom measure and screening tool in ALI survivors.
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Pneumocystis pneumonia (PcP) is an opportunistic fungal infection. Although T-cell immunity is classically related to Pneumocystis defense, recent data support roles for B lymphocytes in the development of PcP in animals, and we have observed several cases of PcP in patients receiving rituximab. These observations prompted a systematic review of our experience to define the spectrum of clinical presentations in which PcP has occurred in the setting of rituximab therapy. ⋯ PcP can occur in association with rituximab, with the majority of cases having also received cytotoxic chemotherapy or significant doses of glucocorticoids. The clinical course of cases of PcP in patients treated with rituximab can be quite fulminant, with significant mortality. Primary prophylaxis should be considered in patients at risk, and secondary prophylaxis provided unless immune reconstitution is well assured.
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Hut lung is a pneumoconiosis caused by exposure to smoke derived from biomass fuels used for cooking in poorly ventilated huts. We report, to our knowledge, the first analysis of the dust deposited in the lungs in hut lung by scanning electron microscopy with energy dispersive x-ray spectroscopy (SEM/EDS). A Bhutanese woman presented with shortness of breath and an abnormal chest radiograph. ⋯ Additional history revealed use of a wood/coal-fueled stove in a small, poorly ventilated hut for 45 years. The possibility of hut lung should be considered in women from countries where use of biomass-fueled stoves for cooking is common. Our findings support the classification of this condition as a mixed-dust pneumoconiosis.
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Critically ill, morbidly obese patients (BMI≥40 kg/m2) are at high risk of respiratory failure requiring invasive mechanical ventilation (IMV). It is not clear if outcomes of critically ill, obese patients are affected by obesity. Due to limited cardiopulmonary reserve, they may have poor outcomes. However, literature to this effect is limited and conflicted. ⋯ Morbidly obese people undergoing IMV have a similar risk for death as nonobese people if only respiratory failure is present. When more organs fail, morbidly obese people have increased risk for mortality compared with nonobese people.
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Patient cooperation is crucial for the success of noninvasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce anticipatory anxiety and acclimatization time in children who are candidates for long-term NPPV. ⋯ Medical hypnosis is an effective, safe, noninvasive, and inexpensive tool for reducing the anticipatory distress and acclimatization time for NPPV. This therapy is particularly useful in children with traumatic experiences, such as a tracheotomy or facial surgical procedures.